Plantar Fasciitis

Plantar fasciitis and other heel pains send more people to foot specialists than just about any other complaint.

The pain came on slowly for Jim Johnston, a 53-year-old Washington, D.C., lawyer who has been running for 22 years. "At first, it seemed like just another pain in the foot, then like a bruised heel," he recalls. "It hurt in the morning on the first step getting out of bed. It hurt when I walked in my street shoes during the day. After two months of trying to run through the pain, I stopped running."

But it was different for Audrey Schnell. "The pain started suddenly, at the bottom of my left foot," says Schnell, a 40-year-old biostatistician in Cleveland, Ohio. "It moved around some and was never so bad that I couldn't run, but I was afraid I'd do serious harm if I continued to train through the pain."

For Andy Schneit, a 51-year-old financial manager from Walnut Creek, Calif., the pain "would start in the foot and shoot up my leg with every stride. I couldn't find any stride that wasn't painful."

The symptoms may have been different, but in all three cases, the diagnosis was the same: plantar fasciitis.

Does your heel hurt, especially when you first get out of bed in the morning? Is the bottom of your foot stiff and achy? Has running become uncomfortable, even agonizing or, worst of all, something you used to do? You're not alone.

Plantar fasciitis and other heel pains send more people to foot specialists than just about any other complaint, and it's one of the most tenacious, frustrating conditions for runners to deal with, experts say. "It's extremely common," says Dr. Sheldon Laps, a Washington, D.C., podiatrist and foot surgeon. "I see it in the young and old, athletic and nonathletic, heavy and thin. It's responsible for the majority of new-patient visits to my office." Many podiatrists believe that plantar fasciitis has replaced knee pain as the most common complaint among runners.

Hardly surprising, since we ask a lot of our heels.

The heel bone is the largest bone in the foot and bears all of the body's weight with each step. As a result, the stress on the heel–and all the structures connected to it–is enormous.

The plantar fascia, a long band of fibers that attaches at the bottom of the heel bone and extends to the base of the toes, takes the brunt of it. Pain occurs when these tissues become irritated or inflamed–a condition known as fasciitis–or when small spurs begin to grow on the heel bone itself.

If you have plantar fasciitis, you may feel a sharp pain first thing in the morning because the plantar fascia shortens during the night, while you're asleep. When you get out of bed in the morning and start walking around, the band along the bottom of your foot stretches and pulls on the heel. When it pulls too hard, pain results.

Causes of Plantar Fasciitis

Biomechanical flaws–including flat feet, high-arched feet and a tight Achilles tendon–can result in considerable stress on the plantar fascia. Weight gain can exacerbate the problem, especially for women who fail to lose extra pounds gained during pregnancy.

Other causes: excessive pronation, sudden increases in training mileage, beginning speedwork or switching surfaces (particularly to concrete sidewalks). Also at risk: women who wear high heels all day and then switch into flat running shoes.

The good news: in most cases, plantar fasciitis can be treated successfully without surgery. The bad news: ultimate success depends on a commodity often in short supply among runners–patience.

"It may take six weeks to three months to heal, or even longer, and that's hard for runners," says Dr. Thomas Clanton, a foot/ankle orthopedic surgeon who serves as team physician for Rice University in Houston, Tex. "I'm a runner myself, so I understand that completely."

Treatment

Medical experts treat plantar fasciitis with many of the usual approaches: stretching; icing after running; oral anti-inflammatories, such as ibuprofen; shoe inserts or custom-made orthotics; night splints and even injections of steroidal anti-inflammatories, such as cortisone.

Surgery, which involves severing the attachment of the plantar fascia to the heel or removing the heel spur, should be considered only when all else fails. Even then, many foot specialists are reluctant to perform it, concerned that it will cause more problems than it will fix.

The mainstay of any treatment program for plantar fasciitis is stretching: specifically, Achilles tendon stretches performed first thing in the morning. You can do one effective stretch while you're still lying in bed. "Loop a towel around the bottom of the foot and pull your toes toward your nose for 30 seconds, and do three sets," Dr. Laps explains. "Then, during the day, do wall pushups with straight legs for one set, then with bent legs. It's best to do the pushups barefoot if possible."

Experts also recommend wearing a heel cup or heel cushion in both running and regular shoes. They urge men to wear an oxford tie shoe during the day. Unlike loafers, tie shoes prevent the toes from curling, a habit that can worsen plantar fasciitis. They suggest women either permanently switch from heels to flats or at least try to run in the morning, before putting on heels.

Some doctors recommend using a night splint, removed in the morning, to keep the plantar fascia from shortening overnight. "At night everybody sleeps with their feet pointing down, and in that position the Achilles and plantar fascia tighten up," Dr. Clanton explains. "That's why it kills you when you first get out of bed. The band suddenly stretches, which perpetuates the problem. By putting a splint on and holding the foot more perpendicular to the leg, you can prevent that."

If these approaches fail, physicians must investigate other possible causes of heel pain, such as a stress fracture, or arthritis caused by Lyme Disease. "As long as the cause of the heel pain is mechanical, it's very easily treatable," Dr. Laps says.

Prevention

In any case, plantar fasciitis is troublesome enough to be worth avoiding, and there are many simple, effective ways to prevent it. Here are the best:

* Wear well-cushioned shoes, and make sure the heels do not become significantly worn.

* Run on soft surfaces. The best: grass, trails, a good track. Worse: asphalt. And worst: concrete.

* Keep your mileage at a relatively consistent level. If you do pick up your training, increase total weekly miles by no more than 10 percent per week.

* When beginning speedwork, ease into it gradually with a several-week buildup.

* Perform Achilles tendon stretches regularly.

* Women: don't wear high heels during the day, then switch to running shoes in the evening. It's probably better to run in the morning and then put on your heels. Or don't wear heels at all.